How to Study for USMLE Step 1

This is a guest post from Eric who blogs at Medical Student Syndrome. Eric scored a 248/99 on USMLE Step 1, which is an excellent score. He was kind enough to share his methods for scoring so well. Enjoy the post and read more at his blog! (Updated for 2013-2014)

A few months ago I took the USMLE Step 1 exam. This is a comprehensive exam covering pretty much everything a medical student is expected to learn the first two years. It is a daunting exam. It is a long exam. And it can even become a pretty emotional exam if you allow it to take control of you. For all of you first and second year medical students who are curious/worried about this exam, let me preface this post be telling you a little bit about myself. I scored a 248/99 on this exam. I was extremely satisfied with that score, and I actually felt that I scored outside of my range. I also do not feel that I am of above average intelligence. As a matter of fact, I can be flat out stupid most of the time. But I worked extremely hard for that score. I studied relentlessly for this exam with a focus that rivals that of a Buddhist monk. And to be honest, you need to be focused and determined in order to score well on this exam. So let’s get into it. How do you score well on this exam?

The first thing that I realized about this exam, and that you should realize as well, is that the people that write this exam don’t really give a s#*t about your dreams, where you came from, or why you want to be a doctor. They don’t care that you want to be an oncologist because your nana died of cancer, or that you want to be a dermatologist because you had bad acne in high school and no one wanted to go with you to prom. This exam is designed for one reason: to make sure that the people who are going into their clinical clerkship years know enough information to hopefully not end up killing someone. This exam is a quality control measure, and for good reason too. Because let’s face it, if your mother came into the ER with fatigue and easy bruising, you’d want to make sure that the student/resident/attending knows what the hell they’re doing or they just might miss her leukemia. But this should get you a little pissed off too. Since this is a pass/fail exam that every medical student must take, the people that make up this exam are the gate keepers and hold all the keys.

Even more ridiculous is that the people who made up this test decided to grade this exam on a point system which incidentally allowed it to become a major pillar in your residency application! So start getting a little pissed off. Get a little fire in your belly. And turn that anger intodetermination! Start telling yourself that you’re going to get a 299 out of spite for the people who are forcing you take this exam in the first place. “Oh, you’re telling me that I have to pass your ridiculous exam? Well not only am I going to pass it, I’m going to dominate it. Take that Mr. Man!”

I should also mention that if you happen have entitlement issues or feel that you are “truly gifted” because you achieved honors in your M1 biochemistry class, lose that now or you’ll end up like this one kid I know. This individual told everyone that he wanted to do dermatology. He honored every 1st and 2nd year class, but got so caught up in his own accomplishments that he felt that the Step 1 exam was beneath him. He didn’t employ a smart study schedule and ended up getting a 228 putting him in a poor position for a dermatology residency spot. That being said, I’ve seen some really intelligent people fail this exam and some extremely unintelligent people pass this exam. What sets them apart is hard work and a smart study schedule.

Okay, so now you have the mindset and the determination to dominate this exam. Now you need to figure out what and how to study. My school gives its students up to one month to study for Step 1. Other schools will vary, but find out how much time your given to study for this exam as soon as you can, because it will factor into how you budget your time. That being said, I would suggest beginning to study for this exam during your winter break of second year. During my winter break, I pulled out my embryology book from M1 year and went through all of the high yield material that coincided with the embryology chapter from First Aid for the USMLE Step 1 (see later). I was thankful that I did this, as it saved me valuable time when it really came time to study for boards. Obviously, you don’t have to study embryology during this time, but study something from your first year of medical school with which you had trouble. Next, after your winter break, try to allocate at least one hour a night to a subject from your M1 year. For example, I set aside an hour to either physiology or biochemistry every night. This time added up; and by the time June rolled around, when it was time to really study for boards, I knew everything about biochem and phys.

Now let’s talk about Step 1 resources. There are two books and two other resources out there that I personally feel are a must need and that anyone who doesn’t utilize these books for Step 1 is an idiot.

1. First Aid for the USMLE Step 1: This book contains what I believe to be 90-95% of all material on which you will be tested. That’sgood. That means that if you can master this book, you will more than likely pass the exam. It is very well put together and is updated annually so only the most high yield concepts are covered. Now if you’re wondering, “My friend gave me his 2010 edition. So, I’m covered, right?” The answer to this question is – maybe. Even though the book is updated every year, there are little changes from edition to edition. But I would highly suggest just buying the newest edition when it comes out in the winter. To prove my point, let’s just look at the math: 4 years of medical school costs around $250,000. This book costs about $30. So buying a new First Aid book will contribute to 0.012% of your overall debt. $30 is a drop in the bucket as far as I’m concerned. Plus, one of the biggest factors in your residency application is your Step 1 score. So if you want to be a competitive applicant, you want to get the best Step 1 score possible, right? So get the newest edition even if you already own last year’s edition. One more thing about First Aid for the USMLE Step 1 – if you can get a .pdf file of this book in addition to the book itself, that may be helpful. I personally found it easier to search through the .pdf file than the book if I was looking for something specific. For example, instead of flipping through numerous pages looking for the effect of loop diuretics on serum calcium, I just typed in “loop” and “calcium” in the search bar of my .pdf application and the exact page I was looking for came right up.

2. Rapid Review Pathology 3rd ed. by Edward Goljan: Okay, this book is the bible for pathology. Dr. Goljan’s anal-retentiveness to mechanism of disease goes hand-in-hand with what Step 1 will ask you. Many questions on the Step 1 exam are asking you about mechanism of action. This book does a great job in laying out how disease processes work. Plus, this book comes with a discount for USMLE consult which is a pretty good Q-bank to go through when you’re trying to understand key concepts (if you’re so inclined to purchase it).

3. Dr. Goljan’s Rapid Review Lectures: I don’t care how you get these lectures, just get them. And make sure you listen to every lecture too. Dr. Goljan does a great job explaining the mechanisms of pathology, makes his lectures entertaining, and gives you confidence in your ability to understand some really difficult concepts.

4. USMLEWorld Q-bank: Don’t get any other question bank. It is almost unanimous that this is the best Q-bank for Step 1. There really isn’t any other Q-bank out there that is even close to measuring up. The only downside is that this resource is somewhat costly. It runs $99 for 1-month, $135 for 2-months, $185 for 3-months, $299 for 6-months and $399 for 12-months. I bought the 3-month subscription and that was enough time for me to go through every question thoroughly. I would suggest going through this Q-bank twice before your exam if you can because it contains such high-yield material and very well written questions.

So what should you do with these absolutely essential materials? Use them! When you are studying during your M2 year for your cardiology exam, crack open Goljan’s Rapid Review and read the cardiology chapter! After that, crack open First Aid and read that cardiology chapter! Familiarize yourself with how these topics are covered in these books during your M2 year; that way, when it comes time to answer a question on congenital heart disease for boards, not only will you know the answer but you will also know the page number on which it was located and the illustrations that were on that page. Also, when you are driving to and from your school doing nothing, why not use that time to study? Throw Dr. Goljan’s audio lectures on your iPod (or your Zune if you’re weird like that) and listen to a GI lecture before your lecture on Inflammatory Bowel Disease at your medical school! And depending on how long you purchased your Q-bank, go through the Q-bank questions that cover the material you are going over in class.

Okay, so now some other things that you may or may not want to purchase:

1) Rapid Review Biochemistry by Edward Goljan: This book is short, sweet, and to the point. If you had trouble with biochem, or just don’t remember any of it, this book may be of some value. This is how I relearned biochem for the boards, and I don’t think that I missed a biochem question on my exam.

2) Cram app for Mac and iPhone (or any other flashcard app for that matter): A portion of boards is about memorizing esoteric facts. What’s the antidote to heparin? What congenital heart defect is seen with lithium use? What receptor does ipratropium act at? Studying for these questions is easy if you have flash cards. But I found that standard flash cards are annoying to make and cumbersome to carry around. So instead, I decided to make flash cards on my laptop with the application Cram. After making flashcards in this program for my Mac, I was then able to transfer them to my iPhone using the iPhone Cram app. This was great to have because it allowed me to learn all the drugs that cause congenital heart defects while standing in line at Chiptole, or antidotes to drugs when I’m eating lunch.

3) High-Yield Neuroanatomy by James Fix: This is not a bad book to have if you struggle with neuroanatomy, neurophysiology, and neuropathology. I’ll say that the neuro chapter in First Aid is more than enough, but this book explains a lot of difficult concepts (something First Aid does not do so well). Again, I would consider getting this resource.

Other resources out there include these board review classes. Programs like Kaplan, Doctors In Training (DIT), Falcon, and others offer a Step 1 review course for a substantial fee. These courses have their pros and cons. I would say that the best quality of these review courses is their structure. For example, I purchased DIT for my Step 1 studies for the simple reason that I didn’t trust myself adhering to a strict study schedule. I knew that if I would try to study on my own, that I would fatigue after a week or two and consequentially wouldn’t have used my study time wisely. DIT solved that for me. They provided a 15 day online review course that forced you to go through First Aid for the USMLE Step 1 in a very methodical way. Now, you may be asking yourself, “Why would I pay someone to talk me through First Aid?” My answer to that is – exactly. Paying for these courses is equivalent to paying someone to read First Aid to you. And I must say, I found DIT extremely boring. As a matter of fact, by the end of the course I was surprised that hadn’t sustained permanent brain trauma from pounding my head against my desk. So just to reiterate, I feel like these courses are really designed for the people who can’t adhere to their own study schedule. But please investigate for yourself, as you might like what they offer.

Lastly, I would like to address your lifestyle during your month of studying for this exam. Studying for 6-12 hours a day, every day, can be absolutely grueling. The keys to surviving this month are finding a daily routine and having good health habits. It should be no surprise that these should go hand in hand. During my month of studying, I forced exercise into my daily schedule. 4-5 days a week I would run for at least 30 minutes. I bought organic foods, drank smoothies, made salads, drank plenty of water, and forced myself to get at least 7-8 hours of sleep a night. I know that this may sound trite, but I felt that it really did make a difference. Studying for this exam takes a toll on your body, so doing all of the right things to make yourself feel better helps. Consider including good health habits into your study schedule.

So that’s about it. That’s what I did to study for Step 1. I hope this was of some benefit. If you already feel overwhelmed, don’t stress out. Just begin to study early, gain some self-confidence, and you’ll be fine. I wish you all the best on your future studies. If you have any questions, please feel free to email me at medstudentsyndrome@gmail.com, and please check out my blog, http://medicalstudentsyndrome.blogspot.com.

Great blog, very insightful and you give a detailed explanation. But I want your advice. I am taking the step 1 in just over 7 weeks. I have gone through First Aid for the appropriate sections through out my 2 years in medical school. Also, this year I have done around 350 Uworld Q’s. But my problem is that I have only listened to 40-50% of the Goljian lectures and maybe 20 % of the Rapid Review. The RR scares me because it is so dense, should I skim over it or read it very carefully and potentially lose time elsewhere?? Also, I am pretty weak in a few areas such as Embryo, any advice would be most appreciated.

First of all, I love your blog!!!!
I read your posts and you increase my selfconfidence and that is hard.
I am a doctor from Peru, and I’m anxious because I read if you are an IMG and want to be a resident here, they won’t choose you if you graduated more than 5 years ago.
I started studying for step 1 , and am currently in USA because I got married to an American citizen and have two kids already.
I’m fixing my schedule and since I can not work yet I’m studying at least 4 hours a day, since my 7 month old baby does not allow me to do more, also have a 10 year old girl but she is ok.
Hope to hear from you.
Anja Cynthia Fernandez Placencia.

I just stumbled upon this blog as I was feeling really low and overwhelmed with my step 1 prep. I grad. 2yrs ago, (IMG) and have finally buckled down to write the step 1. I have 3months which is more than ample time compared to AMGs and yourself. I am using the same materials which you listed, and am doin 8-10 hrs 6days a week. I often second guess myself and abilities but then keep focusing on my end goal.
Thanks for this blog.

Im taking my step 1 in hopefully 6-7months… what review would u recommend for someone who needs to go back to the basics 100% ??? I think i didnt learn things all that well throughout my first 2 semesters (anato, biochem, physio), but studying on my own makes me feel like i wont get the most out of books without a goood teacher for these classes…. help!

Hi, I am an old foreign grad – over 50, 18 years of medical practice, now “stranded” in the USA… In order to start a licensing process in the USA, I have to take all the USMLE exams. That first one (USMLE1 ) that you passed so perfectly, is an 8 hour and really intensive exam, and it is a really hard task even for young students straight from the medical school like you. So, what else but a terrible, primary age discrimination is asking from people like me to take those exams? What do you think?

Hi guys I want some advice for taking step1 I took step1 twice did not make good score then I decided to be an rn did prereq now has to aply in the college but now I am thinking to take step 1 any advice will be appriciated

Great blog I have to say. I am (not strictly speaking) an IMG from Ireland as I am yet to start med school come September. I bought FA and Goljan 2 months ago but due to work commitments, studying has been rather slow. I will be writing step1 in 2016, the plan is to stay sharp and focused in the next two years, studying the above texts along side college studies. Any advice will be well received.